1. Radiation Exposure and Risk John Hamaty

2. Evaluation of Radiation Exposure Levels in Cine Cardiac Catheterization Laboratories American Association of Physicists in Medicine January 1984

3. Introduction High exposure values are due to high exposure times.

4. Excessive Radiation in the Cardiac Cath Lab Traced to improper adjustment and use of: 1) cine imaging chain 2) automatic cine film processor 3) selection of cine floro techniques 4) excessive beam “on” times 5)improper room layout

5. Cine Imaging Chain Measurement of image intensifier input exposure sensitivity (IIIES) Use lower frame rates Higher speed cine film (obsolete) reduce scatter from machine reduce scatter from patient

6. System Description

7. Cine Camera Camera or recording speed is selected by operator at 15-90 frames per second Film is no longer used but floro times remain unchanged Cine run times are set by us now. The longer and greater the exposure time, the greater the radiation time

8. Automatic Exposure Control System Designed to maintain constant light level at the image intensifier output phosphor during filming

9. Radiation Exposure Physical factors which are primary interest include: Cine film image quality Radiation exposure to the patient Exposure to personnel

10. Radiation Exposure One equipment setting that affects radiation levels as well as image quality Image Intensifier input exposure sensitivity (IIIES)

11. IIIES Determined by a number of factors 1) Cine Film Sensitivity(film speed) 2) The f-stop setting of the Cine Camera Lens 3) Image Intensifier Conversion Factor and Quantum Detection Efficiency (QDE) Light Transmission of Optical Distributor

12. IIIES level Adjustment Obtained typically at 80 kVp tube potential 9” mode-10-20 uR/frame 6” mode-20-30 uR/frame This is set by the operator at the AEC control

13. Patient Exposure Total amount of exposure received by the patient is accumulated from the floro exposure. Proportional to the field size selected and the total floro “on” time and the output at the entrance site. Typically 1-5 R/min. If a case lasts 2 minutes of floro then 2-10 Rads per case

14. Patient Exposure Cine exposure is related to number of frames taken and duration of on time Minimized by selecting the lowest filming rate to adequately image patient. If typically 10-25 mR/frame for each view, exposure/frame times total number of frames taken

15. Patient exposure Affected by : 1) filtration 2) anti-scatter grid

16. Personal exposure 1) Orientation of the x-ray beam, patient and personnel 2) Distance between the patient and the location of the personnel 3) Radiation field size/collimation 4) patient size 5) X-ray technique factors